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Home My WebLink About4513-zFORM NO. 4 TOWN OF SOUTHOLD BUn-.~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate ofr Occupancy THIS CERTIFIES that the building located at . ~ ~a. & ~ .V,~. · · Street Map No. ~,. ~O~. Block No ........... Lot No. 8 .&..~ ........ Im~M~ .][,~ .... conforms substantially to the Application for Building Permit heretofore fried in this office dated .........~t ....~,~..., 19 .~ pursuant to which Building Permit No..1~3 .~. dated .............0.~.~....~...., 19.6.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Ae~emm~j. Imtlcl~$. (..llto~ale. e.te) .............................. The certificate is issued to .B~IL Ma~l~.. 01ffx~! .¥:L].fz'e~ .A~alla...~e~l~ ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ ~l. eRe ...................... Building Inspecto¥ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE Ki::F~I' ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) lq? 4513 Z Permission is hereby granted to: .......... ~.~..~...oX.~ ............................. : .................... at premises located at ................... ~j/~J.~.~t..~...~...~..O~.~.%.~L~...~..~J~. ............................................ pUrsuit to application dined ........................... ~....~ ................ , 19.~..~ and approv~ by the Building Inspector. ,':~ ~.5,,.~ ............. INMtM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............ ~.....~.....~...., , 9...~..~. ,orm,t No. Al~roved ........................................ , - Disapproved a/c ?.._.....4 ....... ,x~ ............... ~ .......... ;,,~, .................... (Building Inspector) APPLICATION FO~ BUILDING PERMIT Rte ............ ......................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant· Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building sh~ll be occupied or used in whole or in part for any purpose whatever until a Certificate of Occuponcy shall have been granted by the Building Inspector. - APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Surfak County, New York, and other appJ.icable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or ~lemolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildin~g code, housing C~e, and regulations. -' -: · (~ddress of apl:>'licant) State whether applicant is owner, lessee, agent,'architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No..~al.~.~*3~.~~.: ..J:~.~L~ .... Street and Number ~ ......... ...'~....~.. · Municipality 2. State existing use ond occupancy of premises and intended use ond occupancy of proposed construction: o. Ex~stmg use and occupancy ....... ~ ............... '~. ............................................................................................. occu onc b. Intended use and p y ...................... r~ ........................................................................................ 3. Nature of work (check which applicable): New Building ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... ..~..q~......':~... ...................... Fee ...... ~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ ............... Number of dwelling units on each floor ............................ If garage; number of cars ~ . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ~ .............. 7. D~mensions of. ~-~.~existing structures, if any: Front ..L"~.~.N~r~ear ~c~.x~,~..~. ........... Depth .................... Height · .~...%~.. Number of Stories ....~:~ .~.. .................. . _ __ / _ Dimensions of same structure with a terations or ndditJons: I'ront ....x:Dd~t~4~ ............... Rear .~.e~._~¥1~;~ Depth ................................ Height ............ ;.: ............. Number of Stories ................................ 8. Dimensions of entire new construction: ,Front .....~....~.~. ................ Rear ............................ Depth ........................ Height ---' Number of Stories 9. Size of lot: Front "~....~)~,..I-.'~' ..... Rear --"' Depth 10. Date of Purchase ....... .M.~..~....~... .............................. Nome of Former Owner 1 I. Zone or use district in which premises are situated ......"~.~,'~'_b..~,.~...~m~..~:~.. ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> .~ ................................................ 13. Name of Owner of premJses~...'..~.~.....Address ....~j~,fl~,~......~L.. Phone No~,,~..-...~+~"* Name of Architect ................'. ..................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and shew street names and indicate whether interior or corner lot. STATE OF N ,L=yV~'~' ' ~,e ¢ COUNTy O~ ..~5.....,~,~'~"~_ ............ ~.Y.~ ............... being duly sworn, d~es and says t~ he is the applicant (Name ~f individual sig~ appli~ti~ above named. He is the .................................... ~ ............................ ....................................................... ~ (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm o~ h~e perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this appli~tiOn are tree t~ the best of his ~owledge and belief; and thor the work will be performed in the manner ~t fo~h in the applicati~ fil~ ther~ith. Sw~_to ~fom me this ~~ ....... ........ . , ...................................... ~o. 52.812fi850, Suffolk Term Expires Merch 30, 1~